One London surgeon thinks private operating rooms could be a solution to hallway medicine.

In a city where chronic overcrowding has forced Southwestern Ontario’s largest hospital to implement a policy for treating patients in hallways for lack of beds, Brian Rotenberg is urging the province to consider letting private operating rooms handle surgeries covered by Ontario’s public health insurance plan.

“We could be helping to end hallway medicine right now. Doug Ford has said let’s take patient care out of the hospital, let’s do it. But there’s no mechanism right now to fund that kind of work,” he said.

Rotenberg is the medical director of Advanced Surgical Operatory, a division of Advanced Medical Group. The privately owned Victoria Street clinic includes two state-of-the-art operating rooms – one for various surgeries and another for ophthalmology – a fully-loaded surgical preparation and recovery room and a medical device reprocessing suite.

The London surgical clinic performs procedures that are not, or only partially, covered by Ontario’s public health insurance plan. The centre is accredited by the College of Physicians and Surgeons of Ontario, the province’s professional regulatory body, and authorized to perform certain elective head and neck surgeries, plastic surgeries, urology and gynecological procedures including tummy tucks, eyelid lifts, vasectomy reversals and snoring surgeries.

Surgeons at Advanced Medical Group already are doing surgeries such as cosmetic rhinoplasty, which are not covered by OHIP, but could just as easily be fixing a deviated nasal septum that’s giving a patient trouble breathing, a procedure that would be covered under the provincial health insurance plan.

They have the facility, the staff and expertise to make it happen, Rotenberg said, but they don’t have the provincial funding or clearances to do it.

“Right now patients are basically required to have their surgeries in the hospital because that’s where the funding from the ministry goes,” Rotenberg said. “There’s no mechanism right now to have an out-of-hospital ambulatory facility do fully-insured work. . . We could do fully-insured work today, tomorrow, if there was a mechanism to allow that to take place.”

Rotenberg has sent letters to the Ministry of Health and Long-term Care and the Premier’s Council on Improving Health Care and Ending Hallway Medicine in a bid to put the out-of-hospital operating rooms on the government’s radar.

Ontario has in the past allowed for-profit clinics to perform publicly-funded surgeries by issuing so-called independent health facilities (IHF) licences. The providers may play a role in the government’s avowed shake-up of the public health system that involves establishing regional health leadership panels to oversee medical resource allocation, so-called health teams.

“Independent health facilities providing services covered through OHIP may be partners in an Ontario Health Team to provide connected care centred around patients,” a spokesperson for Health Minister Christine Elliott said in a statement.

“Ontario Health Teams will be a new way to organize and deliver services in local communities with health care providers. . . working as one coordinated team, no matter where they provide care.”

Even if the province allowed clinics to complete OHIP-covered procedures, the facilities aren’t meant to replace or compete with hospital-based surgery suites, Rotenberg said. The goal would be to divert uncomplicated patients with routine surgical needs away from busy hospital operating rooms so they’re available for more serious patients.

“These are healthy people with a single solvable problem. They do not require the entire resources of a huge tertiary care hospital to deal with that. It makes no sense to do small surgeries in big hospitals,” Rotenberg said.

The surgical centre assesses its patients before their procedures and only operates on the lowest-risk ones, said registered nurse and surgical centre manager Edward McGowan. The facility opened in December 2017 and completed 325 surgeries in its first year.

The professional regulator for doctors and surgeons in Ontario oversaw the construction of the operating room facility. The surgery division of Advanced Medical Group is subject to inspections by the college every five years, or more frequently if issues arise.

Advanced Medical Group is one of the 303 college-regulated private facilities in the province that perform procedures with varying levels of anesthesia. The facilities includes everything from laser clinics to medi-spas, pain management centres, fertility clinics up to full operating rooms. The college oversees 13 private facilities in London.

McGowan wants to see the province at least pilot changes that would allow private operating rooms to handle OHIP-insured surgeries.

“I think it’s a real option. I think there’s an opportunity to help alleviate some of the congestion that the hospitals have,” McGowan said, adding de-centralizing routine surgeries also could reduce otherwise healthy patients’ exposure to hospital-acquired infections.

Bolstering private clinics by allowing them to perform publicly funded surgeries could draw talented physicians and nurses away from public hospitals, he said. Private surgical suites also might stray away from treating patients with more complex needs, “cherry picking” the public system can’t abide, Bergmanis said.

“It’s a very disturbing thing,” he said, adding private operating rooms could make it easier for patients to skirt surgery wait lists. “It becomes a case of those who are well-heeled can jump the queue, which is contrary to the Canada Health Act.”

Bergmanis would much rather see the province invest in the existing public health care sector instead of looking to privately funded services to pick up the slack.

“It’s not generating new physicians, it’s not generating any new nursing staff,” he said. “It’s very dangerous.”

Though the prospect of the province partnering with private clinics to provide surgeries is fodder for political debate, one observer said the government already is doing it successfully and has been for at least 15 years.

“There’s precedent. . . Most people I know who run IHFs are operating at full capacity,” said Frank Lista, the chairperson of the Canadian Association for Accreditation of Ambulatory Surgical Facilities. “You could take the pressure off hospitals and do a lot of procedures in these kinds of facilities.”

Lista’s Mississauga and Toronto plastic surgery clinics have an IHF licence and are cleared to perform a set number of OHIP-covered surgeries a year. The province hasn’t issued additional licences in quite some time, Lista said, though he’d like to see the government tapping into private surgical clinics to help reduce surgery wait lists in the public system.

“If the government was really interested in getting some of these procedures out of the hospitals, we could do more, they just have to licence us to do more or licence other places, spread the work around,” he said. “The problem is we try to make hospitals the answer to everything and they can’t be the answer to everything. . . It seems like a perfect solution to overburdened health care.”

Advanced Medical Group surgical clinic

Two operating suites, one for general surgery and another for ophthalmology procedures

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